Classifications of Scarring Alopecia.
Scarring (cicatricial) alopecia is classified as either primary or secondary.
Primary cicatricial alopecia – The hair follicle itself is targeted by a destructive inflammatory process.
Secondary cicatricial alopecia – The hair follicle is not directly targeted. Instead, it is damaged due to trauma, infection, or as the
result of a systemic disease.
Causes of primary cicatricial alopecia:
Lymphocytic inflammation - chronic cutaneous lupus erythematosus (CCLE)
or lichen planopilaris (LPP) and its variants - classic LPP, frontal fibrosing
alopecia (FFA), graham-little syndrome.
Neutrophilic (pus) inflammation - central centrifugal cicatricial alopecia,
folliculitis decalvans/tufted folliculitis, alopecia mucinosa, pseudopelade of
brocq, keratosis pilaris spinulosa decalvans.
Mixed (lymphocytic and neutrophilic inflammation) - dissecting
cellulitis/folliculitis, acne keloidalis, acne necrotica, erosive pustular
dermatosis.
Causes of secondary cicatricial alopecia:
Traumatic - burns, radiation, traction, hot comb or accidental.
Infectious - bacterial, fungal, mycobacterial, treponemal, viral, protozoal.
Developmental defects and hereditary disorders - epidermal nevi, ichthyosis, hair follicle hamartomas, incontinentia pigmenti,
aplasia cutis, focal dermal hypoplasia (goltz), facial hemiatrophy (rombergs syndrome, epidermolysis bullosa, porokeratosis of mibelli,
polyostotic fibrous dyplasia, chondrodysplasia punctata.
Sclerosing (The persistent hardening of tissue) - scleroderma, morphea, lichen sclerosis, sclerodermoid porphyia cutanea tarda,
chronic graft.
Granulamatous (the formation of tiny immune cells) - sarcoidosis, necrobiosis lipoidica, idiopathic.
Primary benign neoplasm (tumor) - cylindroma and other hair follicle and appendage tumors.
Primary malignant neoplasm (cancerous tumor) - basal cell carcinoma, squamous cell carcinoma.
Metastatic secondary malignant neoplasms (cancerous tumor that has spread) - renal, breast, lung, gastrointestinal cancers,
lymphoma, leukemia.
Information on Research and Causes of Alopecias
In the past 20 years, medical research has made significant advances in determining the genetic and environmental causes of a number of human diseases including some causing hair loss. The US National Institute of Health (NIH) in particular has freely available sites to educate the public about medical advances for the diagnosis and treatment of common and rare diseases. The National Organization for Rare diseases (NORD) (www.rarediseases.org) is a helpful source of information. Since medical research on alopecias and hair disorders may be very difficult to understand, there are a number of websites created by hair disorder associated support groups.
Alopecia areata is one of more than 80 autoimmune diseases including rheumatoid arthritis, celiac disease, thyroiditis, early onset insulin dependent diabetes mellitus and lupus erythematosus. The National Alopecia Areata Foundation (NAAF) (www.naaf.org) is a non-profit support group that provides information about and research support for patients with alopecia areata.
NAAF and NIH supported an Alopecia Areata Registry research grant to identify families and individuals with alopecia areata to enable medical researchers to identify specific genetic changes that will lead to better diagnoses and therapies. The impact on these and other medical conditions by studying alopecia areata, a distinctive and visible condition, is easy to understand but not rarely appreciated by the general public.
A similar non-profit support group, Cicatricial Alopecia Research Foundation (CARF) (www.carfintl.org) provides information and raises funds to support research on permanent scarring forms of alopecia.
Discoid Lupus
